| NPI | 1639319387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022045941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036149289) |
| 207Q00000X Family Medicine (Licence: NE 828) | |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2023-02-02 |